VOL: 97, ISSUE: 23, PAGE NO: 48
Rami Jumnoodoo, SRN, RMN, is senior community nurse, the rehabilitation day service at Brent, Kensington & Chelsea and Westminster Mental Health NHS Trust
Elaine Singaram, DipCOT, is head of OT at Brent, Kensington & Chelsea and Westminster Mental Health NHS Trust;Patrick Coyne, BSc, PGDipHSM, RMN, is senior nurse advisor (research), Ealing, Fulham and Hammersmith and BKC&W Mental Health NHS TrustsIn health terms there are two definitions of relapse: the return of the symptoms of a disease from which recovery had apparently been made and the worsening of a condition from which a person was thought to be recovering.
In health terms there are two definitions of relapse: the return of the symptoms of a disease from which recovery had apparently been made and the worsening of a condition from which a person was thought to be recovering.
Recent guidance from the Mental Health Act Commission (1999) emphasised the importance of relapse management in minimising the frequency and duration of periods of relapse in people with a history of mental illness. There has been little formal application of relapse prevention theory so the extent to which it can be applied to recurrent episodes of mental health crisis, which may involve little cognitive and behaviour control, is debatable.
This article summarises the application of a cognitive behaviour therapy model of relapse prevention (Marlatt and Gordon, 1985) by nurses, occupational therapists and other mental health practitioners to a specific subset of people with chronic mental illness. The project was part of the implementation of the National Service Framework for Mental Health (Department of Health, 1999).
One of the main sources of support for this approach is the literature and research evidence on non-compliance with medication. HIV services in particular are noted for their community approach to advocacy and development of user-led services.
The theoretical basis of relapse prevention stems from cognitive behavioural principles (Beck, 1976) and social learning theory (Bandura, 1977). It is underpinned by the notion that people with serious mental health problems can help themselves by taking an active role in the management of their conditions (Orem, 1985).
The main aims of the project were to:
- Help clients gain greater understanding of their condition and the importance of correct management;
- Help clients learn individual coping skills so they can present for help at an early stage of relapse;
- Reduce the duration of relapses.
By taking an active role in managing their own conditions, clients may be able to help determine the most effective medication regime. Among the most important skills they can gain is assertiveness.
The most concrete result of the project was that hospital admissions fell dramatically: during the six months before the project, 12 of the 17 patients had inpatient stays while only five were admitted to hospital in the six months afterwards. Participants commented that areas of particular benefit were medication, crisis planning and increased awareness of relapse signs. Most reported that their needs had been met, along with:
- An increase in motivation and, particularly, greater effort put into self-care routines;
- Greater insight into their illness;
- Greater control over their illness.
While there is evidence that relapse prevention theory can help people with recurrent mental illness remain well for longer and reduce the duration of relapses, further research is needed.
This simple theory and its practice also needs to be taught to carers, GPs, mental health practitioners and, possibly, members of the police service and housing and benefits systems. This would enable a 'whole system' approach to support clients who wish to remain in the community.